Provider Demographics
NPI:1639417157
Name:LOWELL, EMILY POWELL (PHD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:POWELL
Last Name:LOWELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:EILEEN
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7329
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:9 RICHLAND MEDICAL PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6859
Practice Address - Country:US
Practice Address - Phone:803-434-3598
Practice Address - Fax:803-434-1920
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1244103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0522Medicaid